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Context Nationwide data on children diagnosed with craniopharyngioma (CP) are not available in Italy. Objective This work aimed to identify patients’ characteristics, type of surgical approach, complications and recurrences, number of pituitary deficits, and number of patients starting growth hormone (GH) treatment. Methods A retrospective multicenter collection took place of 145 patients aged 0 to 18 years who underwent surgery for CP between 2000 and 2018, and followed up in 17 Italian centers of pediatric endocrinology. Results Age at diagnosis was 8.4 ± 4.1 years. Duration of symptoms was 10.8 ± 12.5 months and headache was most frequent (54%), followed by impaired growth (48%) and visual disturbances (44%). Most lesions were suprasellar (85%), and histology was adamantinomatous in all cases but two. Surgical approach was transcranial (TC) in 67.5% of cases and transsphenoidal (TS) in 31.%. The TC approach was prevalent in all age groups. Postsurgery complications occurred in 53% of cases, with water-electrolyte disturbances most frequent. Radiotherapy was used in 39% of cases. All patients but one presented with at least one hormone pituitary deficiency, with thyrotropin deficiency most frequent (98.3%), followed by adrenocorticotropin (96.8%), arginine vasopressin (91.1%), and GH (77.4%). Body mass index (BMI) significantly increased over time. A hypothalamic disturbance was present in 55% of cases. GH therapy was started during follow-up in 112 patients at a mean age of 10.6 years, and 54 developed a recurrence or regrowth of the residual lesion. Conclusion CP is often diagnosed late in Italy, with TC more frequent than the TS surgical approach. Postsurgery complications were not rare, and hypopituitarism developed almost in all cases. BMI shows a tendency to increase overtime.

The effects of growth hormone (GH) treatment on 24-h energy expenditure (EE) were studied in a open trial over a period of 4 weeks. Five subjects, four men and one woman, with a history of complete GH deficiency were included. All the subjects were examined on 2 consecutive days on baseline and, thereafter, at six occasions during a period of 1 month (days 1, 2, 5, 8, 15, and 30). The dose of GH was 0.25 U/kg·week, administered sc once a day in the evening. EE was determined in a chamber for indirect calorimetry. Body composition was determined with dual-energy x-ray absorptiometry and computed tomography using a four-scan technique. Blood samples were examined using well-established RIAs. During the first 2 weeks, 24-h EE increased by 6 ± 3% (range 1–8%) from 40.9 ± 4.8 to 42.9 ± 4.8 kcal/24 h·kg (P < 0.05), sleeping metabolic rate by 14 ± 3% (range 10–18%) from 28.4 ± 1.9 to 32.9 ± 2.2 kcal/24h·kg (P < 0.001), and basal metabolic rate by 11 ± 7% (range 0–18%) from 29.6 ± 2.4 to 33.3 ± 2.6 kcal/24h·kg (P < 0.05). No change was found in daytime EE. The increase in EE covaried with changes in insulin-like growth factor 1, the free T3/free T4 ratio, insulin-like growth factor-binding protein-3, and the aminoterminal procollagen III peptide but not with changes in body composition. It is suggested that the stimulating effect of GH on EE occurs gradually during a 2-week period and is only detectable during night and morning hours, when significant levels of GH occur.

IN PREVIOUS papers we have been able to adduce evidence that regulation of protein metabolism exists. We tested the regulation by a double administration of a protein test meal (gelatine). In normal persons a second administration 3 hours following the first either does not produce any rise of the amincacid level of the blood, or at the most a very small rise (1). Further analysis revealed hormonal and central nervous influences (2, 3, 4). The regulating effect was found to be missing in cases of pituitary deficiency, pituitary cachexia, (3). This indicates that a factor of pituitary origin is involved in protein metabolism, and that tests of this factor may be made by the method of double administration of gelatine. The fact that in normal cases the second administration of gelatine is not followed by a rise in the blood amino N could be explained as due to a regulation in which the anterior pituitary lobe is of first significance.

In a preceding communication (1) the diagnosis and therapy of combined androgenic deficiency and seminal inadequacy were considered. However, deficiencies in seminal function are observed commonly in males who present no evidences of androgenic failure or other sexual incompetency as evaluated by present diagnostic criteria. Moreover it is unlikely that pronounced grades of hypogonadotropic failure exist in these patients for, if that were true, androgenic deficiency states would likewise be noted. The consideration of seminal inadequacy alone, therefore, assumes definite clinical importance. Impairment of seminal function of the male, unaccompanied by androgenic failure, may be due to several factors: a) intrinsic testicular failure due to maldescent; b) extra-endocrine factors; c) altered metabolism due to thyroid disease; d) altered metabolism due to adrenal disease; e) inadequate gonadotropic activation of the germinal epithelium due to low-grade pituitary deficiency; and f) intrinsic germinal failure...

THE GROWTH PATTERN of an individual is the resultant of a number of forces. Among the factors intrinsic to the organism are the “inherent growth impulse,” the thyroid hormone, and a pituitary principle which has been called the growth hormone. Whether or not there may occur in man a constitutional defect of the growth impulse (as might be suggested in some cases of dwarfism by failure to find any other lack and by failure to stimulate growth by thyroid and pituitary preparations) is not known. That dwarfism may occur as the result of either thyroid or pituitary deficiency is abundantly shown both in the laboratory and in the clinic. An accumulation of evidence shows that the pituitary and thyroid are closely interrelated in their metabolic and growth affecting functions. MacCallum and Fabyan (1) described shrunken eosinophilic cells in the pituitary of a human cretin. Zweckwer, Davison, Keller and Livingood (2) ascribed cretinic dwarfism to loss of eosinophils from the pituitary secondary to loss of thyro...

Clinical studies of pituitary cachexia (Simmonds’ disease) (1) are fairly common. Calder (2) reviewed the literature up to 1932 and cited 70 cases. Since this time several new observations have been recorded. In no instance was reference made to a preceding acromegaly. Pituitary cachexia in its severest form denotes failure of the entire hypophyseal mechanism or at least complete failure of the anterior lobe. In 1928 Bailey and Cushing (3) described a syndrome termed ‘fugitive acromegaly’ in which the early evidences of acromegaly were replaced by a state of pituitary embarrassment. The terminal phenomenon, namely, cachexia, weakness, increased carbohydrate tolerance, etc., may well have been due to a failure of the acidophilic elements alone. Controlled clinical observations of such a selective pituitary deficiency are comparatively rare.

IN VIEW OF THE LACK OF EVIDENCE, secured from the studies of the preceding communication, that the cyclic administration of equine gonado’ tropins affords any significant salvage in anovulatory ovarian failure, and because the theoretical and experimental considerations reviewed previously indicated that in the cases of the monkey and woman augmentation or synergism1 of equine gonadotropin with chorionic gonadotropin was doubtlessly necessary for full supplementation of pituitary deficiency, the present study was made. It is concerned with the assessment of effectiveness of a system of one'two cyclic therapy with equine and chorionic gonadotropins. The rationale of this form of therapy has been considered in detail in the preceding communication.

Diversified types of eunuchoid patients were employed in this study in order to learn what influence the presence of testicular tissue had on effective doses of testosterone. Two patients were bilateral cryptorchids, 21 and 33 years of age, in whom no testicular tissue was demonstrable. Two others were 20 and 31 years of age and had undeveloped retractile testes which apparently were either nonfunctioning or which gave evidence of a minimal amount of activity. The fifth patient had had an unilateral orchipexy performed but was deficient in testicular function. The sixth patient exhibited definite hypogenitalism which was associated with a primary gonadotropic pituitary deficiency. Subcutaneous implants of testosterone as a method of treatment in cases of testicular deficiency were introduced experimentally by Deanesly and Parkes (1). Following this, reports of the clinical application of this method of therapy appeared in the literature (2). To be clinically expedient, a mode of therapy should be effectiv...

We have studied, in 6 normal persons and 6 patients with hypopituitarism, the new way of measuring thyrotropin reserve proposed by Jensen. We have calculated the thyroidal clearance of iodine (CIT), plasma inorganic iodine (PII), absolute uptake of iodine (AUI) before and 36 hr after a small dose of carbimazole (15 mg/day) for a week. PII increases by 0.09 ± 0.03 μg/100 ml in controls and remains constant in patients with pituitary deficiency. This increase is significantly related to the pretreatment PII level. It seems therefore a simple and reliable test of TSH reserve.